HOME: THE JOHN LAVERTY, JR. CASE-- FALSE SBS CHARGES, WRONGFUL CONVICTION & IMPRISONMENT

THE "SHAKEN BABY SYNDROME" MYTH: Why top scientists say it isn't possible to shake an infant hard enough to cause the symptoms used to diagnose SBS and the probable real causes

http://www.jpands.org/vol11no1/leestma.pdf

Shaken Baby Syndrome: Do Confessions by Alleged Perpetrators Validate the concept?

Jan E. Leestma, M.D., M.M.

ABSTRACT
The concept that a certain constellation of findings develops immediately after a baby is shaken, with no impact to the head, is based solely on confessions or admissions by alleged perpetrators. The reliability of confessions in the setting of interrogation by law-enforcement officials is questionable. A review of the literature reveals very few cases of admissions of pure shaking. Methodologic flaws preclude any definitive conclusions about causation from these cases.

The Origins of the Shaken Baby Syndrome

The shaken baby syndrome (SBS) is embedded in the collective minds of the public, law enforcement, prosecuting attorneys, child-protection personnel, and physicians.

The concept was largely derived from the papers of Caffey (1, 5), a radiologist specializing in pediatric cases. He had for years suggested that the multiple limb fractures he observed in babies were the result of abuse. It was not until Kempe and his associates at the University of Colorado Medical Center in Denver published their seminal article in 1962 (6) that the theories of Caffey and others began to gain acceptance.

A sensational case of a child-care nurse who admitted to shaking and killing three babies in her care (an insane person--Ed.) attracted Caffey's (5) attention, and he apparently thought that her admission explained what he had been seeing for years but had been unable to explain. Caffey now theorized that multiple fractures of the lower extremities and other bones as well as subdural hemorrhages in apparently abused babies were caused by the flailing legs and a head flopping back and forth with shaking. This mechanism, without any scientific evidence to support it, made intuitive sense to him and others, and thus was born whiplash-shaking and later the shaken baby syndrome.

http://www.jpands.org/vol11no1/leestma.pdf (read the article for the rest of the story)

Conclusions

The confessions or admissions of a perpetrator are at best tenuous support for the shaking mechanism for infantile head injury. A critical appraisal of any literature that proposes a causal mechanism of shaking for brain injury must include an evaluation of case selection methodology, population or sample size, possible case control issues, data analysis methods, and whether the conclusions reached are justified by the data presented.

Another vital issue, often overlooked, is a critical evaluation of literature cited. Unless the reader is very well informed on the issues and is intimately familiar with the literature, this component of an informed appraisal of an article almost never gets done, and the reader may accept the conclusions uncritically.

Jan E. Leestma, M.D., M.M is board certified in anatomic and neuropathology, and is a consultant in neuropathology at Children’s Memorial Hospital of Northwestern University Medical Center, Chicago.

Potential Conflict of Interest: Dr. Leestma has been engaged to provide expert testimony in various criminal and civil cases, including some involving alleged SBS. contact: jleestma@aol.com.

REFERENCES

1. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma
Am J Radio 1946;56:163-173.

2. Caffey J. Some traumatic lesions in growing bones other than fractures and dislocations: clinical and radiological features Radiol 1957;30:225-238.

3. Caffey J. On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 1972;124:161-169.

4. Caffey J. The parent-infant traumatic stress syndrome (Caffey-Kempe syndrome) (battered baby syndrome). Am J Radiol 1972;114:218-229.

5. Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental
retardation Pediatrics 1974;54:396-403.

6. Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered child syndrome.JAMA 1962;181:105-112.

7. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. BMJ 1971;2:430-431.

8. Eisenbrey AB. Retinal hemorrhage in the battered child. Child's Brain 1979;5:40-44.

9. American Academy of Pediatrics (Committee on Child Abuse and Neglect: Kairys SW, Alexander RC, Block RW, et al.): Shaken baby syndrome: rotational cranial injuries—technical report (T0039). Pediatrics
2001;108:206-210

10. Duhaime AC, Gennarelli TA, Thibault LE, et al. The shaken baby syndrome: a clinical, pathological, and biomechanical study. Neurosurg 1987:66:409-415.

11. Prange MT, Coates B, Duhaime AC, Margulies SS. Anthropomorphic simulations of falls, shakes and inflicted impacts in infants. Neurosurg 2003;99:143-150.

12. Bandak FA. Shaken baby syndrome: a biomechanics analysis of injury mechanisms. Forensic Sci Int 2005;151:71-79.

13. Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Brit J Neurosurg 2002;16:220-242.

14. Goldsmith W, Plunkett J. A biomechanical analysis of the causes of traumatic brain injury in infants and children. Am J Forensic Med 2004;25:89-100.

15. Donohoe M. Evidence-based medicine and shaken baby syndrome. Part I. Literature review 1966-1998. Am J Forensic Med Pathol 2003;29:239-242.

16. Leestma, JE. Case analysis of brain injured, admittedly shaken infants: 54 cases. Am J Forensic Med Pathol 2005;26:199-212.

17. Scheibner V. Shaken baby syndrome diagnosis on shaky ground. Austr Coll Nutr & Env Med 2001;2:5-8,15.

18. Duhaime AC, Gennarelli TA, Sutton LM, Schut L. The “shaken baby syndrome”: a misnomer? J Pediatr Neurosciences (Riv Neuroscienze Pediariche--It) 1988;4:77-86.

19. Plunkett J. Fatal head injuries caused by short-distance falls. Am J Forensic Med Pathol 2001;22:1-12.

20. Tongue AC. Guest editorial: the ophthalmologist’s role in diagnosing child abuse. Ophthalmology 1991;98:1009-1010.

21. David TJ. Shaken baby (shaken impact) Syndrome: non-accidental head injury in infancy. J Roy Soc Med 1999;92:556-561.

22. Biron D, Shelton D. Perpetrator accounts in infant abusive head trauma brought about by a shaking event. Child Abuse Negl 2005;29:1347-1358.

23. Starling SP, Patel S, Burke BL, et al. Analysis of perpetrator admissions to inflicted traumatic brain injury in children. Arch Pediatr 2004;158:454-458.

24. Conti RP. The psychology of false confessions.
Credibility Assessment Witness Psychol 1999;2:14-36.

25. Kassin SM. On the psychology of confessions: does innocence put innocents at risk? Am Psychol 2005;60:215-228.

26. Leo RA, Ofshe RJ. The consequences of false confessions: deprivations of liberty and miscarriages of justice in the age of psychological interrogation. J Crim Law & Criminol 1998; 88:429-497.

27. Foster KR, Huber PW. Cambridge, Mass.: MIT Press; Judging Science, Scientific Knowledge and the Federal Courts. 1997.

28. Greenhalgh T. London, England: BMJ Publishing Group; How to Read a Paper: The Basics of Evidence-Based Medicine 1997.

29. Hadley MN, Sonntag VKH, Rekate HL, Murphy A. The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 1989;24:536-540.

30, Lazoritz S, Palusci VJ, eds. The Shaken Baby Syndrome.A Multidisciplinary Approach New York, N.Y.: Haworth Maltreatment & Trauma Press; 2001.

31. Howard MA, Bell BA, Uttley D. The pathophysiology of infant subdural haematomas. Brit J Neurosurg 1993;7:355-365.

32. Greenes DS, Schutzman SA. Occult intracranial injury in infants Ann Emerg Med 1998;32:680-686.